CCM Under the Microscope: Are Your Providers Documentation-Ready? Written by: Christine Hall, CHC, CPC , CDEO, CPB, CPMA, CRC, CEMC, CPC-I Chronic Care Management (CCM) services are getting extra attention from Medicare Administrative Contractors (MACs) as part of their Target, Probe, and Educate (TPE) program. They are closely reviewing CCM claims for possible misuse, which…
Before You Bill Incident To—Is the Treatment Plan Really There? Scott Kraft, CPC, CPMA, CEMC, CPA-RA Whenever you perform an audit under Medicare’s Incident to billing rules, you’re really auditing two different things. First, did the visit note support the code assigned and whether it included any documented changes to the patient’s treatment plan. Second,…
Prescription Drug Management Requires More Than a Medication List Written by: Jill Young What documentation is required to show a provider is performing prescription drug management? It has been a question since the changes to the Office or Other Outpatient Services codes was announced by the American Medical Association (AMA) in 2021. The table Elements of Medical Decision…
Incident-to Billing Revisited: Chasing the 15% Written by: Shannon O. DeConda | NAMAS, a division of DoctorsManagement, LLC Incident-to billing, as defined by the Centers for Medicare & Medicaid Services (CMS), has long been both a point of interest and a source of confusion among healthcare providers. For many years, the prevailing advice among compliance…
A Stark Law Overview for Non-Legal Minds Written by: David M. Glaser, Shareholder | Fredrikson Health Law Stark is perhaps the most difficult of health law regulations, which may explain why there are so many misunderstandings about it. The first source of confusion is that the law is commonly called an “anti-self referral law.” But…